Scarless surgery in treating scars

Konstantinos Anastassakis MD, PhDHead & Neck Surgeon

Athens, Greece

What is a scar?

Scar is the visible final state of the natural skin healing process.

Besides scratches, every wound results in some degree of scarring.

Causes of scars

wound scars (trauma)surgical scars acne scars (inflammation)burn scars (contracture)

There are several different kinds of scarring, each caused by differing amounts of collagen over

expression.

Facts about scars

And this is for the…developed world only

No data on the rest 5.7billion humans

Numbers on scars

500.000.000cm=5.000.000m =5000km of scars/year

Everybody has a scar, unless he lives in a bubble…

Good things about scars

Great conversation starters, help people be creative in storytelling.

Good things about scars

BADBAD things about scars

For physicians, scars are a source of frustration

Patients regard scars as stigma!Substantial physical, psychological, emotional & financial costs.

• Burn them

• Melt them

How do we treat scars until now

• Grind them

Actually destructively with ablative procedures

Replace scar with another scar, hopefully

shorter or thinner

We must

stop being destructive…

and start to be constructive!

(NO ablative procedure can meet these requirements! )

How we SHOULD treat scars?

Both are physiological requirements to be fulfilled

A rational & RECONSTRUCTIVE approach!

Micro-needling

Micro-needling devices

Usual, traumatic needles injure skin!Just like a scalpel!

Even though tiny, it is still

there!

A Non-Traumatic micro-needle(Ø = 0,25 mm) compared with a 27G injection needle

(Ø = 0,4 mm)

Non-traumatic micro needles and penetrate the dermis without cutting it, they just part skin cells!

Micro-needling: How it works?

How it works:

Injury stimulus on dermisAlarming signal for stem cell attractionRelease of NATURAL growth factorsVertical scar perforation“Nothing to repair” Filling of the old scar bed

How it works:

Typical Micro-Needlingapplications

Acne scars Facelift scars, Parotidectomy, Thyroidectomy, Oncologic

Surgery Surgical abdominal scars (appendectomy, Cesarean

section, abdominoplasty etc) Thoracic scars Breast augmentation, breast reduction, breast

reconstruction scars Orthopedic scars (Knee, femoral, upper arm, vertebral) Hair transplantation scars (Strip procedure scars, scalp

reduction or scalp extension scars) Burn contractures Striae

Scars to treat with P.C.I.T.

Atrophic-Depressed Hypertrophic-

Elevated Contracture Acne scars

Microneedles and atrophic scars

“Too Little” is complemented (collagen addition).Microneedles stimulate skin stem cells and cause skin cells to proliferate new fibroblasts migrate into the scar-bed and fill it with new collagen layers.

Microneedles and hypertrophic scars

“Too Much” is decomposed (Scar degradation)•Different cells are stimulated to degrade old collagen strands.Most probably microneedling stimulates enzymes (proteinases) to degrade scar tissue

Still ELUSIVE

Example of stained skin cross-section from a

biopsy Collagen fibers stained

purple are increased up to

1000% and to a depth of

0.5 to 0.6 mm

X 20 times magnification

New Collagen is stained purple.

Preparation & Procedure

Procedure

gentle pressure, roll the roller over each area in

each direction, vertically, horizontally and in both

diagonalsuntil you get an even pattern of petaechie

Procedure

Immediately after session 24hrs after session

Acne scars

2 treatments P.C.I.T., 12 weeks apart

2 treatments, 12 weeks apart

Ice pick scars on the forehead

37

Scar improvement 4 weeks after 1st treatment

4 sessions of Microneedling

Source: Jaihsree Jarad, Bombay/India

Source: Jaihsree Jarad, Bombay/India

4 sessions of Microneedling

Acne scars after 2 sessions

Good clinical improvement after 4 treatments

Courtesy by Prof. P. Niwat

Courtesy by Prof. P. Niwat

Great improvement of moderate atrophic acne scars after 4 treatments

Burn scars

Burn scar - 1 treatment

Source: Med. Hochschule Hannover

3 months post-op


Improvement after 1 treatment,

3 months post-op.

Burn scars on forearm


3 months post-op

Facial burn scars


1 treatment, 7 months post-op

A 3 years old post-burn hypertrophic, hyper pigmented scar on the posterior surface of the left calf. Before and 8 months after 1 procedure of micro-needle session.

1 treatment, 4 months post-op

Other types of scars

3 treatments, 6 months after last session

Stretch marks, 2 treatments

Micro-Needling Advantages

NO post-op pain. NO side-effects. Minimal social down time. Any area of skin can treated (around the

eyes, neck, dorsum of hands) Even areas previously LASER-(mal)treated. No damage on skin. No use of xenobiotics (Collagen Fillers etc.)

Microneedling

is Re-CONSTRUCTIVE

NOT ablative

Contraindications

Never use on infected skin

Avoid using on keloids and moles

[email protected]

Konstantinos Anastassakis MD, PhDHead & Neck Surgeon

Athens, Greece

Scarless surgery in treating scars

Health & Medicine

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